Krim-Kongo Hämorrhagisches Fieber

[Birgitt]

CRIMEAN-CONGO HAEMORRHAGIC FEVER - KAZAKHSTAN (03): (KYZYLORDA)
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 9 Jun 2010
Source: Kazinform, Astana [in Russian, trans. MASTA, edited]
[Not on the English version of their website]
<http://www.inform.kz/rus>


Child diagnosed with Crimean-Congo haemorrhagic fever in Kazakh south
---------------------------------------------------------------------
Medical workers in [southern Kazakhstan's] Kyzylorda Region have
confirmed the diagnosis of Crimean-Congo haemorrhagic fever (CCHF) in
a 12-year-old child, the press service of the Kazakh Ministry of
Emergency Situations has said.

According to the source, at 2230 [local time, 1630 GMT] on 7 Jun 2010,
a 12 year-old boy was admitted to the Zhanakorgan district hospital
for infectious diseases near the Akkum station in Kyzylorda Region on
suspicion of having contracted CCHF. Medical workers confirmed the
diagnosis at 1830 on 8 Jun [2010]. The patient's condition remains
serious.

Anti-epidemic measures are being taken at the location [where he
caught] the disease.

[Monitor's note: an outbreak of CCHF was reported in the Kazakh south
in the summer of 2009, and a man died of this disease in South
Kazakhstan Region on 18 May 2010; see ProMED archives below.]

--
Communicated by
Michelle Sellors
Specialist Nurse Travel Health
MASTA Ltd
<http://www.masta.com>

[Photo of CCHF patient with hemorrhages all over the back:
<http://pathmicro.med.sc.edu/parasitolog ... hagic2.jpg>
Map of the world distribution of CCHF:
<http://www.who.int/csr/disease/crimean_ ... 080918.png>
- Mod.JW]

[The interactive HealthMap/ProMED map for Kyzylorda is available at:
<http://healthmap.org/r/01w6> - CopyEd.EJP]

[Birgitt]

Kasachstan - Krim-Kongo hämorrhagisches Fieber
15.06.2010

Die Behörden der Provinz Südkasachstan melden erneut einen Fall von Krim-Kongo hämorrhagischem Fieber. Erst im Mai dieses Jahres waren 7 Fälle vom CCHF bestätigt worden (2 Todesfälle). Schutz vor Zecken beachten. / Quelle: crm

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - KOSOVO (02)
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 14 Jun 2010
Source: Overseas Security Advisory Council (OSAC), Consular Affairs
Bulletins, Warden Message [edited]
<https://www.osac.gov/Reports/report.cfm ... tID=118367>


Kosovo: Crimean-Congo hemorrhagic fever awareness
-------------------------------------------------
Kosovo is experiencing a cyclical outbreak of Crimean-Congo hemorrhagic
fever (CCHF), which is endemic to this area. From 26 Apr to 9 Jun 2010 the
National Institute of Public Health of Kosovo (NIPH) has reported a total
of 75 hospitalizations, including 4 deaths, due to CCHF.

There is no safe and effective vaccine widely available for human use.
People living in endemic regions should avoid areas where there are many
ticks, particularly in the spring and summer. The following safety
precautions are recommended:

- wear light-colored clothing that covers legs and arms;
- if living in infested area, check whole body regularly for ticks; remove
ticks gently but promptly;
- examine clothes regularly for ticks;
- use tick repellents on skin and clothing;
- tuck trousers into socks and keep sleeves rolled down;
- clean areas where food is prepared or served well so as not to leave food
pieces;
- maintain neatness and cleanliness;
- keep pet areas clean and sanitized; and
- check your pets frequently for fleas and ticks, and use flea & tick
collars and shampoos.

CCHF is a severe disease in humans, with a high mortality rate.
Fortunately, human illness occurs infrequently. The disease may be more
frequent in local livestock. Ticks may act as a vector between the animal
and humans. The victims of this outbreak have been from rural areas, and
urban areas are typically spared. The cases have been reported from
Malisheve/Malisevo municipality (11 cases), Rahovec/Orahovac municipality
(3 cases), Theranda/Suva Reka municipality (one case), Hani i Elezit/Elez
Han municipality (one case), and Gjakove/Dakovica municipality (one case),
as well as one case from northern Albania.

The NIPH advises there is nothing unusual about this particular outbreak
and the unfortunate loss of life associated with this illness. Outbreaks of
CCHF typically occur at this time of year and often result in a number of
deaths. According to NIPH the areas of highest incidence are rural areas.

A map showing areas of Kosovo where the outbreaks are occurring is attached
to this Warden Message
<https://www.osac.gov/Reports/report.cfm ... tID=118367>, as are
instructions from the United State Centers for Disease Control and
Prevention website on how to remove ticks
<http://www.cdc.gov/ncidod/dvbid/lyme/Pr ... _Avoid.htm>.

Signs and symptoms of the disease include: sudden onset of high fever,
headache, backache, and abdominal pain; small hemorrhages of the eyes; and
a type of rash in the mouth and on the trunk of the body.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[The disease situation in Kosovo is substantially unchanged from that
reported in the previous ProMED-mail report on Wed 9 Jun 2010, but this
Warden Message provides some useful information for travellers in the region.

An excellent overview of Crimean-Congo hemorrhagic fever virus infection,
entitled "A re-emerging, potentially deadly illness" by ProMED-mail
moderator Arnon Shimshony can be accessed at
<http://www.infectiousdiseasenews.com/article/64303.aspx>. An interactive
map of Kosovo is available at
<http://travel.nationalgeographic.com/tr ... osovo-map/>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN ex AFGHANISTAN, REQUEST FOR
INFORMATION
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 26 Jun 2010
Source: AllVoices, local global news [edited]
<http://www.allvoices.com/contributed-ne ... in-kp-fata>


In the wake of [an outbreak of Crimean-Congo haemorrhagic fever] in the
border areas of neighbouring Afghanistan, the Health Ministry has alerted
the health departments of Khyber Pakhtunkhwa (province) and FATA about this
fatal virus [infection]. [The FATA (Federally Administered Tribal Areas)
are a group of small administrative units in the north west of Pakistan,
lying between the Khyber Pakhtunkhwa and the neighboring country of
Afghanistan. They comprise 7 tribal agencies and 6 smaller frontier
regions, with considerable autonomy from the rest of Pakistan. A map of the
FATA is available at <http://en.wikipedia.org/wiki/File:FATA_%288%29.jpg>.
- Mod.CP]

According to local sources, the deadly outbreak occurred in the Afghan
province of Helmand where Crimean-Congo haemorrhagic fever (CCHF) virus
infection had been confirmed in 7 people.

The Ministry had directed the provincial health authorities to remain
vigilant and collect data concerning Afghan refugees who were being treated
in various hospitals in the province, adding that the authorities had been
instructed also to send blood samples obtained from patients with suspected
CCHF to the federal capital for laboratory tests.

It has also been reported that all the public sector hospitals in the
province have been instructed to take precautionary measures to avoid the
spread of the virus. Security officials at the Torkham border [crossing]
have also been ordered to strictly monitor the movement of refugees at the
border.

CCHF is transferred to humans through tick bite or through direct contact
with blood or other infected tissues from livestock infected with the virus
[and also by nosocomial transmission in hospital. - Mod.CP]. Symptoms
include fever, aching muscles, dizziness, neck pain and stiffness,
backache, headache, sore eyes, and sensitivity to light. Other clinical
signs that may emerge include rapid heart rate, a dramatic drop in platelet
and white blood cell counts, bleeding from the upper bowel, blood in the
urine, nosebleeds, and bleeding gums. The severely ill may develop liver
and kidney failure after the 5th day of illness. In patients who recover,
improvement generally begins on the 9th or 10th day after the onset of illness.

[byline: Musarrat Ullah Jan]

--
communicated by:
ProMED-mail <promed@promedmail.org>

[This report indicates that there have been 7 confirmed cases of CCHF virus
infection in the Afghan province of Helmand, which is adjacent to the
Khyber Pakhtunkhwa (province) and FATA of Pakistan. An alert is in force,
and there may be CCHF cases among refugees from Helmand in hospitals in
Pakistan. It is unclear whether there have been as yet any confirmed cases
in Pakistan. Further information from the region would be welcomed.

The HealthMap/ProMED-mail map of Afghanistan can be accessed at:
<http://healthmap.org/r/00-5>, and the map of Pakistan at
<http://healthmap.org/r/00tj>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - NAMIBIA: (KARAS)
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 2 Aug 2010
Source: AllAfrica, The Namibian report [edited]
<http://allafrica.com/stories/201008030900.html>


Although not back on his cattle and sheep farm yet, a Namibian Congo fever
[Crimean-Congo hemorrhagic a fever] patient has been discharged from
hospital. He was discharged from the Bloemfontein Medi-Clinic on Friday [30
Jul 2010]. According to his wife they decided that he should stay behind in
South Africa for the rest of the week to recuperate. This, she said, was
also because she was still recovering from the flu, and "should there be a
problem", he would be close to the doctors who had taken care of him the
last 2 weeks.

His wife returned to their farm, on Saturday [31 Jul 2010]. Their 2
children had stayed on the farm for the past fortnight, monitoring their
own health to make sure that they had not contracted the deadly fever. Last
week [week ending 1 Aug 2010], the farmer's wife was also admitted to
hospital after her temperature rose to over 38 deg C [100.4 deg F]. It was
feared that she also had the deadly disease. She was discharged a day
later, when laboratory results showed she did not have Crimean-Congo
hemorrhagic fever.

Earlier, Dr Jack Vries of the Ministry of Health and Social Services urged
Namibians to remain calm but vigilant. He said it was the first outbreak of
the disease, which closely resembles Rift Valley fever (RVF), in the
country for the past 8 years. Crimean-Congo hemorrhagic fever, mainly
spread by tick bites, is a notifiable disease.

The country also experienced an outbreak of RVF -- the first since 1985 --
this year [2010]. Last week [week of 26 Jul 2010], the United Nations (UN)
praised Namibia for successfully fighting the outbreak without losing any
human lives.

[byline: Denver Kisting]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever
caused by a virus belonging to the genus _Nairovirus_ of the family
_Bunyaviridae_ . Although primarily a zoonosis, sporadic cases and
outbreaks of CCHF affecting humans do occur. The disease is endemic in many
countries in Africa, Europe, and Asia. Outbreaks were recorded in South
Africa in 2008. Recent outbreaks are listed below.

The geographical distribution of the virus, like that of its tick vector,
is widespread. Evidence of CCHF virus has been found in Africa, Asia, the
Middle East, and eastern Europe. Health care workers in endemic areas
should be aware of the illness and the correct infection control procedures
to protect themselves and their patients from the risk of nosocomial
(hospital-acquired) infection.

CCHF virus may infect a wide range of domestic and wild animals. Many birds
are resistant to infection, but ostriches are susceptible and may show a
high prevalence of infection in endemic areas. Animals become infected with
CCHF from the bite of infected ticks.

Humans who become infected with CCHF acquire the virus from direct contact
with blood or other infected tissues from livestock during this time, or
they may become infected from a tick bite. The majority of cases have
occurred in those involved with the livestock industry, such as
agricultural workers, slaughterhouse workers, and veterinarians.

The length of the incubation period for the illness appears to depend on
the mode of acquisition of the virus. Following infection via tick bite,
the incubation period is usually 1 to 3 days, with a maximum of 9 days. The
incubation period following contact with infected blood or tissues is
usually 5 to 6 days, with a documented maximum of 13 days. Onset of
symptoms is sudden, with fever, myalgia (aching muscles), dizziness, neck
pain and stiffness, backache, headache, sore eyes and photophobia
(sensitivity to light). There may be nausea, vomiting, and sore throat
early on, which may be accompanied by diarrhoea and generalised abdominal
pain. Over the next few days, the patient may experience sharp mood swings,
and may become confused and aggressive. After 2 to 4 days, the agitation
may be replaced by sleepiness, depression, and lassitude, and the abdominal
pain may localize to the right upper quadrant, with detectable hepatomegaly
(liver enlargement).

The mortality rate from CCHF is about 30 per cent, with death occurring in
the 2nd week of illness. In those patients who recover, improvement
generally begins on the 9th or 10th day after the onset of illness. More
detailed information concerning the care and treatment of patients who have
contracted CCHF can be found at
<http://www.who.int/mediacentre/factshee ... index.html>.

Namibia is located in south west Africa bordered by Zimbabwe and South
Africa (<http://www.worldatlas.com/webimage/countrys/af.htm>). A map
showing the regions of Namibia can be seen at
<http://en.wikipedia.org/wiki/Regions_of_Namibia> and the
HealthMap/ProMED-mail interactive map of the country can be accessed at
<http://healthmap.org/r/02et>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (02): (KARACHI)
**********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 16 Sep 2010
Source: Dawn, local news [edited]
<http://www.dawn.com/wps/wcm/connect/daw ... -weeks-690>


Another Congo fever case reported in 2 weeks
--------------------------------------------
A young tannery worker who was admitted to the city government-run
Abbasi Shaheed Hospital (ASH) for the treatment of dengue fever has
tested positive for viral Crimean-Congo haemorrhagic fever (CCHF)
virus infection as well. It was the 2nd such case of CCHF reported
from the city hospitals during the short span of 2 weeks, said
medical circles, adding that the 1st patient had been discharged from
a private hospital after his recovery.

Reports about 2 deaths from CCHF in July [2010] and the preceding
months this year set alarm bells ringing and the city and health
practitioners and relevant authorities have stressed the need [to
undertake] urgent preventive measures.

The medical superintendent of the ASH, Dr Hamid Zaheer, told the Dawn
[newspaper] on Wednesday [15 Sep 2010] that a 23-year-old patient, a
resident of Sector 9/E, Orangi Town, [had been] brought to the
hospital with pain, high-grade fever and respiratory problems. "As I
have been told by doctors, the patients bled 2 days back, following
which in addition to initial tests and symptomatic treatment, some
serological tests were conducted and it was known by Tuesday [14 Sep
2010] that the patient had tested positive both for dengue fever
[virus] and CCHF [virus] infections. Initially he was kept in the
intensive care unit, but now [he is being treated] in an isolation
ward of the hospital, while the doctors and paramedics have also been
asked to observe the appropriate protocol while [treating] the
patients in question," Dr Zaheer stated.

Of the 5 patients tested positive for the viral disease [CCHF} since
March [2010], 2 have survived, while one is under treatment at the
ASH.

The death of a patient, in his mid-thirties, a resident of Bismillah
Colony, Landhi, was confirmed by the Indus Hospital, Korangi, in July
[2010]. This patient was a butcher by profession -- said to be one of
the most vulnerable jobs to contract the highly infectious disease.
The occupation of the other patient who died from CCHF in May was not
known.

Some of the experts after knowing about the CCHF [cases] in July had
highlighted the need to undertake a retrospective study of CCHF
patients, [to determine] their occupations and their contact with
other people during the period of incubation of the virus, and to
determine the sensitivity of lab results and [communication of] a
timely update by the hospitals on the cases to the health authorities.

The deputy medical superintendent of the ASH, Dr Javed Akhtar, said
that the [23-year-old patient currently being treated], a worker at
tannery, was admitted to the hospital on Sat 11 Sep 2010 and was kept
in the Medical-III [ward] initially and then was transferred to the
medical intensive care unit (ICU) in view of his deteriorating
condition.

The laboratory of the Aga Khan University Hospital (AKUH) informed
the hospital on Tue 14 Sep 2010 of positive test results for dengue
fever virus infection and CCHF virus infection, and as a result the
patient was transferred to an isolation ward.

Relatives of of the patient had also been debarred from meeting him,
the doctor said, adding that the patient was being provided with
blood platelets, which had critically decreased. Replying to a
question, Dr Akhtar said that the AKUH laboratory handed over the
formal serology test report to the ASH on Wednesday [15 Sep 2010] for
this patient, who is now being given all possible care and is now in
a stable condition and conscious.

The head of the infections control committee of the AKUH, Dr Bushra
Jamil, told Dawn that the AKUH lab had tested 2 samples positive in
recent days for CCHF -- one pertained to a patient admitted to the
AKUH and discharged after recovery a week ago, and the other the
sample received from the ASH.

An expert said that the doctors and paramedics [known] to have come
into contact with these patient during treatment, and relatives of
the patients, also needed to be kept under observation as a
preventive measure. It is worth noting that a few years back a doctor
handling a patient suffering from CCHF later died of the same
disease. [Nosocomial transmission of infection in hospitals in
Pakistan has been recorded previously. In 2002, a female doctor
contracted CCHF virus infection from a patient and died. 2 doctors
involved in her treatment also contracted infection; both survived
(see: ProMED-mail post - Crimean-Congo hemorrhagic fever - Pakistan
(02) 20020313.3735).]

Previously, in 1974, a physician died in Rawalpindi General Hospital
as a result of CCHFV infection contracted from patients. - Mod.CP]

[Byline: Mukhtar Alam]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The geographical distribution of CCHF virus, like that of its tick
vectors (_Hyalomma_ spp.), is widespread. Evidence of CCHF virus has
been found in Africa, Asia, the Middle East and Eastern Europe.
Health care workers in endemic areas should be aware of the illness
and the correct infection control procedures to protect themselves
and their patients from the risk of nosocomial (hospital-acquired)
infection.

Humans who become infected with CCHF acquire the virus from contact
with blood or other infected tissues from livestock, or they may
become infected directly from a tick bite. The majority of cases have
occurred in those involved with the livestock industry, such as
agricultural workers, slaughterhouse workers and veterinarians.
Following infection via tick bite, the incubation period is usually
one to 3 days, with a maximum of 9 days.

The incubation period following contact with infected blood or
tissues is usually 5 to 6 days. Onset of symptoms is sudden, with
fever, myalgia (aching muscles), dizziness, neck pain and stiffness,
backache, headache, sore eyes and photophobia (sensitivity to light).
There may be nausea, vomiting and sore throat early on, which may be
accompanied by diarrhoea and generalised abdominal pain. Details of
the subsequent course of the illness can be found at:
<http://www.who.int/mediacentre/factshee ... index.html>.

The mortality rate from CCHF is approximately 30 percent, with death
occurring in the 2nd week of illness. In those patients who recover,
improvement generally begins on the 9th or 10th day after the onset
of illness.

Of the 5 CCHF patients treated in the city of Karachi in recent
months, 2 (a butcher and a tannery worker) have worked with livestock
or livestock products. The case of the 23-year-old tannery worker
described in the above report is exceptional in that the patient has
tested positive for 2 unrelated hemorrhagic fever viruses -- dengue
fever virus (a flavivirus) and CCHF virus (a bunyavirus). Further
information on the course, treatment and outcome of the tannery
worker's illness are matters of general interest and would be
welcomed.

The HealthMap/ProMED-mail interactive map of Pakistan, showing the
location of the city of Karachi can be accessed at:
<http://healthmap.org/r/00tj>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (PUNJAB)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 22 Sep 2010
Source: The News International [abbreviated & edited]
<http://www.thenews.com.pk/22-09-2010/islamabad/5981.htm>


A female patient, who has been undergoing treatment at the Shifa
International Hospital after being suspected as a patient with
Crimean-Congo haemorrhagic fever (CCHF), has been confirmed positive
for the infection by the National Institute of Health (NIH).

The female patient who belongs to Village Toot, Dhoke Golguppa of
Tehsil Pindigheb, Attock [district, Punjab province] was brought to
the Holy Family Hospital [HFH], Rawalpindi, on 14 Sep 2010 with
high-grade fever and continued, uncontrolled nasal and throat
bleeding, while bleeding from her skin and rectum was also reported.
The patient, aged 35, had earlier undergone treatment at a private
hospital in her native town for 2 days, but her fever did not subside.

The HFH, after suspecting the female patient to be a case of CCHF,
sent her blood sample to the NIH, Islamabad, which declared the
patient positive for the infection on Mon 20 Sep 2010. "At HFH, blood
transfusions were administered to the patient, but she was not
improving significantly," said the patient's brother while talking to
The News on Tue 21 Sep 2010. "One of our acquaintances advised us to
take her to Shifa International Hospital." He added that they took
the patient to Shifa International Hospital on 16 Sep 2010, where she
is now improving. "We have gone beyond our limits and have spent
nearly Rs 0.2 million [USD 2350] so far on treatment of the patient,
who has 2 daughters and 2 sons."

The mortality rate for hemorrhagic fevers [such as CCHF] ranges from
50 to 90 per cent. Persons with [such infections] experience
headache, high fever, muscle pain and vomiting along with internal
and external bleeding. According to the NIH guidelines, CCHF is
caused by a nairovirus (family _Bunyaviridae_) transmitted to humans
by the bite of _Hyalomma_ spp. ticks or by direct contact with blood
of an infected animal or human. CCHF was 1st described in Crimea in
1944 and identified in 1956 in the Congo. Nearly 300 confirmed cases
of CCHF have so far been reported in Pakistan from 1976 to 2003. The
disease was 1st reported in Pakistan in 1976, but the number of cases
has shown a dramatic rise since 2000.

The News has learnt that the victim, who has been undergoing
treatment in the Intensive Care unit of Shifa International Hospital
in strict isolation, is improving. When she was taken to Shifa
International Hospital, she was bleeding from the nose, mouth and
rectum and had bruises on her skin. Her haemoglobin level had dropped
to 5 from 14. At Shifa hospital, she has been given blood and
platelets along with treatment, and now she is improving, said Fateh
Khan. He said, however, that treatment costs from Rs 30 000 to Rs 35
000 [USD 350-400] per day, and the family is not in a position of
retaining treatment at Shifa Hospital. "We want to shift the patient
to some public sector hospital like the Pakistan Institute of Medical
Sciences (PIMS), Islamabad, but it seems difficult, keeping in view
the condition of the patient" [At the time of this report, the
funding of the patient's further treatment had not been resolved. - Mod.CP].

CCHF is a highly infectious disease. It is relevant that nearly 7
years back, a female doctor of Holy Family Hospital died after
developing CCHF while treating a CCHF patient. Earlier, some 3
decades back, a renowned health professional in the city also died of
the infection while trying to treat a CCHF patient.

[Byline: Muhammad Qasim]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[The circumstances whereby the patient became infected are not
stated, but she resided in a rural area of Pakistan and could have
been exposed to infected ticks or had contact with the blood of
infected animals. Further information on the background to this case
and the outcome of her treatment would be welcomed.

A map showing the location of the Attock district of Punjab province
can be accessed at: <http://en.wikipedia.org/wiki/Attock_District>.
The HealthMap/ProMED-mail interactive map of Pakistan is available
at: <http://healthmap.org/r/00tj>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (03): (PUNJAB) NOSOCOMIAL
********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 30 Sep 2010
Source: Dawn.com, Islamabad [edited]
<http://www.dawn.com/wps/wcm/connect/daw ... -virus-090>


4 female doctors and as many other staff members have contracted the
deadly Crimean-Congo Haemorrhagic Fever (CCHF) virus at the Holy
Family Hospital [HFH], setting alarm bells ringing in the city and the
health department to take preventive measures to avoid further
outbreaks of the disease.

Doctors at the hospital told Dawn on Wednesday [26 Sep 2010] that
blood samples of 4 female doctors, 2 nurses, one student nurse and a
ward boy sent to the National Institute of Health (NIH) had been
confirmed positive for the infection. The doctors and staff have been
shifted to the Intensive Care Unit (ICU) for treatment.

The doctors contracted the infection while dealing with 2 patients
being treated at the hospital. One patient had been brought to the HFH
on Tue 14 Sep 2010 and later moved to the Shifa International
Hospital, Islamabad [see: ProMED-mail post: Crimean-Congo hem. fever -
Pakistan (03): (PB) 20100923.3440]. Another CCHF patient died at Holy
Family Hospital on Fri 24 Sep 2010, 2 days after being admitted there.
The HFH administration has sent blood samples of its staff members to
the NIH as precautionary measures.

Dr Javed Hayyat, who is supervising treatment of the patients, told
Dawn that the female doctors were feeling well and there were no
symptoms of CCHF; however, the 2 nurses were suffering from fever. He
said the doctors [are believed to have] contracted the virus during
the past 12 days. "No symptoms were developed, and the said virus [was
no longer evident] after 2 weeks, if the patient had not [exhibited]
fever," he said.

When contacted, HFH Medical Superintendent Capt. (retired) Dr Fayyaz
confirmed that blood tests on the 8 staff members were positive for
CCHF. "We had sent the blood samples of those dealing with the CCHF
patients to NIH, and these 8 have tested positive for the viral
disease," he said.

He said only 2 nurses had developed symptoms; however, the symptoms
had not developed in the female house officers. "After consultation
with Rawalpindi Medical College Principal Dr Afzal Farooqui and other
senior specialists, we have started treatment [ribavirin treatment?]
of the patients," he said. He said further blood samples from the 8
patients had been dispatched to the NIH.

CCHF haemorrhagic fever is a zoonotic disease that animals [transmit]
to humans. In Pakistan, the 1st human outbreak [of CCHF] was reported
in 1976 at Rawalpindi, when a doctor died while treating a patient at
the Central General Hospital (now Benazir Bhutto Hospital). A
25-year-old intern physician also died at Holy Family Hospital in 2002
while treating a Congo fever patient.

[Byline: Aamir Yasin]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[It is unclear whether there is any connection between these patients
in Rawlpindi and the patients with an undiagnosed illness, which may
be CCHF, now under treatment in the neighboring province of
Khyber-Pakhtunkhwa (formerly North-West Frontier Province) and the
single CCHF patient under treatment in Karachi (Sindh province).
Clarification would be welcomed.

In view of the past tragic history of nosocomial cases of CCHF in
Pakistani hospitals, it is surprising that there has not been greater
awareness of the danger of nosocomial infection. It may be that this
is another unfortunate consequence of the devastation associated with
the recent flooding throughout the Indus valley.

The HealthMap/ProMED-mail interactive map of Pakistan, accessible at
<http://healthmap.org/r/00tj>, can be used to locate the provinces of
Khyber-Pakhtunkhwa, Punjab and Sindh. - Mod.CP]

[I find this report confusing; the 4 doctors are said to be in the
ICU, but the "house officers" -- presumably the same doctors -- had no
symptoms; in which case, why are they there and why were their blood
specimens sent for testing? Perhaps they are there in lieu of a
quarantine ward, and are being tested & treated preventively. I also
find it sad that hospital staff are so uninformed about CCHF cases
occurring in other states of their country -- don't they read the
newspapers or ProMED? -- and apparently do not take the proper
precautions when treating a patient with a hemorrhagic disease. -
Mod.JW]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (04): (PUNJAB)
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 1 Oct 2010
Source: newdawn.com Islamabad [edited]
<http://www.dawn.com/wps/wcm/connect/daw ... pitals-100>


More Crimean-Congo fever suspects land in Pindi hospitals
---------------------------------------------------------
The city hospitals on Thursday [30 Sep 2010] received 15 patients with
symptoms of the deadly Crimean-Congo haemorrhagic fever (CCHF) from
Chakwal and adjoining areas. A total of 11 patients were admitted to
Holy Family Hospital (HFH) and 2 each to District Headquarters (DHQ)
Hospital and Benazir Bhutto Hospital. The doctors said that [the
patients] had been suffering from fever for the last 6 days and some
of the patients' gums had started to bleed.

They said that the doctors suspected them to be patients with CCHF.
They were shifted to the intensive care unit (ICU) and their blood
samples were dispatched to the National Institute of Health (NIH) for
testing for CCHF and dengue fever. They said that the hospitals would
receive the blood test report on Friday [01 Oct 2010] and if the
patients tested positive for the disease the doctors would start to
provide medication in an isolation room.

Doctors at Holy Family Hospital said that as many as 7 patients came
from tehsil [administrative zone] Dhudyal, Chakwal; one patient from
Chakwal city and the rest [5] from Rawalpindi city. They said that 2
patients with symptoms of dengue and CCHF also came to hospital from
Chakwal but they expired on Wednesday night [29 Sep 2010]. They said
that the dead were handed over to their families on Thursday morning.
Talking to Dawn, Dr Javed Hayat of Holy Family Hospital said, "the
patients have been kept under observation in an ICU and their
treatment will start as soon as the hospital receives their blood test
report."

Replying to a query about the staff of the hospital who had contracted
the CCHF, Dr Hayat said that their condition was stable and they were
being provided with all available medical treatment. He said, "Though
the blood tests of the doctors were positive, no symptoms have
appeared."

The Benazir Bhutto Hospital medical superintendent, Dr Asif Qadir Mir,
said that the blood samples of 2 patients had been sent to the NIH and
they would receive a report on Friday [01 Oct 2010].

DHQ hospital medical superintendent Dr Sher Ali Khan also confirmed
that there were 2 patients in the hospital and the doctors suspected
them to be cases of CCHF. He said that the medical treatment of the
patients would be started after they received reports from the NIH.
However, he said that the doctors were monitoring the condition of the
patients in an isolation ward.

[Byline: Aamir Yasin]

--
Communicated by:
Andrew S.
Philadelphia, PA, USA
<mathleteowl@aol.com>

[If all of the suspected cases are confirmed by laboratory diagnostics
this outbreak will prove to among the largest outbreaks of CCHF
recorded in Pakistan. In addition to the nosocomial infections in the
HFH hospital in Rawalpindi, suspected patients are being referred from
different parts of Punjab province. The routes of exposure of these
patients and their occupations have not been disclosed.

Under normal conditions CCHF infection is restricted mainly to those
involved with the livestock industry, such as agricultural workers,
slaughterhouse workers and veterinarians. It may be that the recent
disastrous flooding in the Indus valley has exposed humans to direct
infection from the _Hyalomma_ tick vector of CCHF virus. The most
important source for acquisition of CCHF virus by ticks is believed to
be the small vertebrates on which immature _Hyalomma_ ticks feed.

Further information is awaited on the outcome of the diagnostic tests
now in progress.

A map of Punjab province can be accessed at:
<http://pamirtours.pk/maps/punjab%20map.htm>, and the
HealthMap/ProMED-mail interactive map of Pakistan is available at
<http://healthmap.org/r/00tj>. - Mod.CP]

[Given the high index of suspicion of CCHF in these cases, it seems
dangerous to postpone treatment until the results of the blood tests
are known. One hopes that the families to whom the the expired
patients are returned have been told of the danger of contact with
their blood or excretions. It is again unclear whether the medical
staff in Holy Family Hospital are symptomatic or merely in isolation
under observation. - Mod.JW]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (05): (KHYBER-PAKHTUNKHWA)
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 2 Oct 2010
Source: The News, International [edited]
<http://www.thenews.com.pk/02-10-2010/National/7853.htm>


Tests confirm Abbottabad doctor died of CCHF
--------------------------------------------
The mysterious death of a resident medical officer (RMO) at the Ayub
Teaching Hospital (ATH), has been attributed to Crimean- Crimean
hemorrhagic fever (CCHF), hospital management said on Friday (1 Oct
2010) [This was 1st described in the ProMED-mail post "Undiagnosed
fatal illness - Pakistan: (NW) 20100927.3505"].

Medical Superintendent of the hospital Dr Iftikhar told The News that
the laboratory reports from the National Institute of Health (NIH) had
confirmed the death of the doctor was due to CCHF virus infection.
CCHF is a viral disease that occurs primarily in animals but humans
are also susceptible to it. The disease is indigenous to many African,
European and Asian countries. Being a tick-borne disease, the majority
of the people who contract the virus are involved in the livestock
industry.

The deceased doctor caught fever and died after spending a night in
Bisham, Shangla district, where he had gone to perform duties at the
health facility established for people affected by floods. He was
treated at the ATH but could not survive.

The younger brother of the deceased doctor has been showing the same
symptoms for the past few days with intermittent [increased]
temperature and low platelet [counts]. Sources said the ATH
administration had no infectious diseases specialist and had decided
to refer the patient to the Pakistan Institute of Medical Sciences in
Islamabad.

After the confirmation of death of the doctor due to to CCHF virus
infection, the hospital administration sent blood samples of his
relatives and hospital staff to the laboratories in Islamabad. It also
decided to provide free medical treatment to all the relatives of the
deceased doctor. A special ward has been set up at the Dental Block
where all patients suspected of having the disease will be kept in
isolation. Another ICU unit will also be established in the hospital
to provide medical treatment for dengue, bird flu and CCHF patients.
It is worth mentioning here that there is no virologist or infectious
disease specialist in Khyber Pakhtunkhwa [province].

The Executive District Officer (Health) in Mansehra, Dr Javed Tanoli,
told reporters that 4 more patients suspected to be suffering from
CCHF had been hospitalised. Dr Tanoli said the district health
department was taking protective measures in Mansehra. He said the
samples of the 4 suspected CCHF patients admitted to the King Abdullah
Teaching Hospital, Mansehra, were also sent to NIH for tests and
confirmation of the infection. Dr Tanoli said after the death of the
hospital doctor, the district health department was adopting
precautionary steps in accordance with the World Health Organisation
guidelines.

[Byline: Syed Kosar Naqvi)

--
Communicated by:
Andrew S.
Philadelphia, USA
<mathleteowl@aol.com>

[This press report confirms that that the fatal undiagnosed illness
suffered by a resident physician at the Ayub Teaching Hospital (ATH)
in Abbottabad, Khyber-Pakhtunkhwa (previously North-West Frontier
Province) was in fact Crimean-Congo hemorrhagic fever as suggested as
a possibility in the original ProMED-mail report. A verdict on other
cases at the ATH is awaited. In view of the number of new suspected
cases accumulating and the nosocomial cases in Rawlpindi it may be
that the infection is spreading from person to person rather than from
infected livestock or via the tick vector.

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at:
<http://healthmap.org/r/00tj>. - Mod.CP]

[For readers who are wondering what a disease named Congo-Crimean
hemorrhagic fever is doing in Pakistan, thereby hangs a tale. The
disease was first identified as the cause of an epidemic in the
Crimean peninsula in the Black Sea in the former USSR. Years later,
the virus was isolated from the blood of a febrile patient in the
former Belgian Congo by a Belgian doctor, and sent to the regional
reference lab, which was the East African Virus Research Institute
(EAVRI) in the British colony of Uganda (now the Uganda VRI). There
it was isolated by staff and sent by me to the world reference lab at
the Rockefeller Foundation Virus Laboratory in New York, where it was
found to be new. I asked the Belgian what he would like to name it,
and he said Congo virus, which is the name I published it under.
Later, the Soviets succeeded in isolating the virus from their own
patients, and were surprised to find it was Congo virus. They decided
this would never do, hence the current name. It has since been found
to be carried by migrating birds and their ticks all over their
migration routes in much of the Old World. - Mod.JW]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (08 ): (PUNJAB), NOT
**************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 13 Oct 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/61895/dengu ... ngo-fever/>


Dr Javed Hayyat, in charge of the Infection Control Committee at Holy
Family Hospital (HFH), has stated that there have been no reported deaths
of [suspected] Crimean-Congo hemorrhagic fever (CCHF) patients in Holy
Family Hospital (HFH). Two patients who were suffering from dengue fever
were mistakenly diagnosed with Congo fever [CCHF].

Talking to the Express Tribune, Dr Hayyat said the hospital mistakenly
announced incorrect figures because the staff got confused between the test
reports of dengue and Congo [CCHF] patients issued by the National
Institute of Health (NIH). "The hospital administration received
information of test reports from NIH on the phone and mistakenly declared 2
patients positive for dengue [fever] as positive for [CCHF]," he explained.

The 1st patient suspected of CCHF was brought to the hospital on 14 Sep
2010. Since then, 20 more CCHF-suspected patients have been admitted, 10 of
whom were tested positive by the NIH. He said only 3 of the patients
diagnosed with CCHF are currently [still] in the hospital; the rest have
been discharged after full recovery.

Dr Hayyat said there has been no decline in the number of patients with
suspected CCHF and dengue coming to the hospital. A total of 139 patients
with suspected dengue fever have been admitted to the hospital since 19 Jan
2010, 15 [of whom] had positive tests for the disease by NIH. He said the
hospital is awaiting test results from NIH for 37 inpatients suspected of
having dengue fever.

--
communicated by:
HealthMap alerts via
ProMED-mail <promed@promedmail.org.


[Apart from presumptive seasonal cases of CCHF in Baluchistan, there have
only been 3 reliably confirmed cases elsewhere in Pakistan. These were
described in detail in the preceding post entitled "Crimean-Congo hem.
fever - Pakistan (07): revised data, WHO 20101009.3670".

In view of the misdiagnoses reported above, independent confirmation of the
new suspected CCHF cases admitted to the HFH and the 10 apparently
NIH-confirmed CCHF cases is urgently required. Likewise, the status of the
presumed nosocomial infections previously described (about which there is
some uncertainty) also needs independent verification.

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at:
<http://healthmap.org/r/0dcu>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - PAKISTAN (09): (KHYBER-PAKHTUNKHWA)
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 15 Oct 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/62851/four- ... ngo-fever/>


Test results show 4 more positive for CCHF
------------------------------------------
A total of 4 more people have been diagnosed with Crimean-Congo hemorrhagic
fever (CCHF) at Ayub Medical Complex, Abbottabad. Reports received from
National Institute of Health (NIH) on Tue 12 Oct 2010 confirmed that the
patients were suffering from CCHF. Ironically, all 4 patients were
discharged a few days ago and the hospital is unaware of their whereabouts.

Talking to the Express Tribune, deputy medical superintendent (DMS) Dr
Junaid said the hospital had sent 8 blood samples to National Institute of
Health, 4 of which tested positive for CCHF [virus infection]. He said the
4 patients had been admitted in medical ward A of Ayub Medical Complex
Hospital but were discharged a few days ago because "their condition did
not seem serious".

The hospital administration does not have addresses of the patients,
however, he said that 2 of them belonged to Mansehra, one was from Rajoya
village in Havalian, while the whereabouts of the [3rd and] 4th patients
are unknown. Sources inside the hospital said the pathology department was
responsible for maintaining records of these patients. They said a young
resident medical officer (RMO) of ATH [Ayub Teaching Hospital] died of the
disease a few days back. Since [the doctor's death] the hospital received
16 patients suspected [to have contracted] CCHF and their blood samples
were sent to NIH for tests. All these patients were admitted in the
hospital's medical ward A and later discharged, sources said.

The ATH administration has constituted a team including DMS Dr Junaid,
Professor Dr Shamim Anwar and Professor Dr Javed, who, after holding a
meeting with a World Health Organization representative, have established
quarantine measures for CCHF patients in the ATH and arranged 500
protective kits. "Beside lab procedures, early identification of the
disease is very important," said Dr Athar Lodhi, director of IPP [sorry, we
do not know what this stands for. - Mod.SH] and Planning at ATH.

[A] quarantine area to treat such patients has been established next to the
IPP ward, which is putting other patients at risk. "I have requested the
chief executive of the hospital to shift the quarantine to a safer
location," he added.

--
Communicated by;
ProMED-mail
<promed@promedmail.org>

[In contrast to the situation at the Holy Family Hospital in Rawalpindi the
5 cases (an RMO and 4 patients) at the Ayub Teaching hospital in Abbottabad
appear to have been confirmed by diagnostic testing at the National
Institute of Health. Other suspected CCHF cases still await confirmation.
Apart from the deceased RMO, none of the confirmed and suspected cases
seems to be seriously ill.

However this press report reveals serious lapses in record keeping and
infection control procedures at the Ayub Teaching Hospital and the extent
and source of the CCHF outbreak in Khyber Pakhtunkhwa (formerly North West)
province remains uncertain.

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed at
<http://healthmap.org/r/00tj>. - Mod.CP]

[Birgitt]

HEMORRHAGIC FEVERS - PAKISTAN (02)
**********************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
(1) Sindh province
(2) Khyber Pukhtoonkhwa province
(3) Punjab province

****
(1) Sindh province
Date: Tue 02 Nov 2010
Source: Samaa News [edited]
<http://www.samaa.tv/News27391-Congo_vir ... ients.aspx>


Crimean-Congo hemorrhagic fever virus detected in 2 patients
------------------------------------------------------------
Crimean-Congo hemorrhagic fever (CCHF) virus has been detected in 2
patients at a private hospital in Karachi on Thursday [28 Oct 2010].
According to sources [?], so far 29 patients of CCHF virus have been
reported across the country. A special CCHF ward has been set up in
the same hospital, sparking fear among staff and other patients.
Sources say that the hospital is trying to hide the information about
the patients' condition.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[On 26 Oct 2010 the Pakistan Ministry of Health and the World Health
Organisation(WHO) reported 26 cases of CCHF and 3 deaths. Now 2
additional CCHF cases have been reported in Karachi (Sindh province),
thus leaving one other fatal case unaccounted. - Mod.CP]

****
(2) Khyber Pukhtoonkhwa province
Date: Tue 02 Nov 2010
Source: The Express Tribune [edited]
<http://tribune.com.pk/story/71184/dengu ... bbottabad/>


Hemorrhagic fever deaths in Abbottabad
--------------------------------------
At total of 4 deaths have been reported as a result of Crimean-Congo
hemorrhagic fever (CCHF) and [or?] dengue fever, while the National
Institute of Health has confirmed 4 more cases of CCHF virus at the
Ayub Teaching Hospital Abbottabad (Khyber Pukhtoonkhwa province).

Deputy Medical Superintendent ATH Dr Junaid also confirmed that
laboratory reports conducted by the National Institute of Health
(NIH) on 4 more patients confirm that they have CCHF but no one at
ATH was able to tell if these patients were still admitted or have
been discharged from the hospital. Earlier 4 Congo-positive patients
were discharged from the hospital a few days ago and even their
whereabouts are not known to the hospital authorities.

So far, more than 150 cases of dengue fever have been confirmed in
Abbottabad. Executive District Officer (EDO) Health Dr Zafeer claimed
that the administration of Ayub Teaching Hospital (ATH) is hiding
facts and is not cooperating with the health department despite the
fact that the maximum number of such cases was admitted in ATH.

Hazara Commissioner Sahibzada Muhammad Anees has also confirmed the
presence of 37 cases of dengue fever other than those being treated
in the ATH. Blood samples of 167 suspected patients were sent to NIH
of which 37 have been confirmed as having dengue fever.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[It is unclear from the information provided in this press report
whether these CCHF cases in Abbottabad are new cases or cases already
included in the list of confirmed cases issued on 26 Oct 2010 by the
Pakistani Ministry of Health and the WHO. - Mod.CP]

****
[3] Punjab province
Date: Tue 02 Nov 2010
Source: Online News [edited]
<http://www.onlinenews.com.pk/details.php?id=169593>


CCHF virus: Health Ministry unaware of 12 deaths
------------------------------------------------
The Health Ministry turns out to be unaware of 12 deaths due to
Crimean-Congo hemorrhagic fever (CCHF) virus infection. 12 people
among 9 health officials in Holy Family Hospital Rawalpindi (Punjab
province) have died due to this virus.

Responding to questions raised in the National Assembly in this
regard, the Parliamentary Secretary for Health Mehreen Razzaq Bhutto
said that the Ministry of Health is unaware of deaths in such large
numbers [as a consequence of] CCHF and she could [not] answer the
question [until further] information in this regard [becomes
available]. She said that the deaths might be due to dengue virus as
symptoms of CCHF and dengue are similar.

--
Communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[The only conclusions possible are that CCHF and dengue fever are
prevalent throughout Pakistan and although case numbers are
increasing the the precise numbers of cases and fatalities are
uncertain. There are more cases of dengue fever than CCHF which is
not unexpected in view of the different modes of transmission of
these 2 hemorrhagic fevers (mosquito-borne versus tick-borne transmission).

Overall there is evidence of confusion in diagnosis, deficiencies in
record-keeping and deliberate deception. The statement of the
Parliamentary Secretary for Health Mehreen Razzaq Bhutto deserves
commendation for its clarity and honesty.

For more information on these diseases see the WHO CCHF
website
(<http://www.who.int/csr/disease/crimean_ ... index.html>), and
the WHO Dengue/dengue haemorrhagic fever website
(<http://www.who.int/csr/disease/dengue/en/index.html>).

The HealthMap/ProMED-mail interactive map of Pakistan can be accessed
at <http://healthmap.org/r/00tj>. - Mod.CP]

[Birgitt]

CRIMEAN-CONGO HEMORRHAGIC FEVER - IRAN
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 25 Nov 2010
Source: Eurosurveillance 2010; 15(47): article 5 [summ. and edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19720>


Phylogenetic analysis in a recent controlled outbreak of Crimean-Congo
haemorrhagic fever in the south of Iran
-----------------------------------------------------
Summary
-------
Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a
high mortality rate in humans. The CCHF virus is transmitted to humans
through the bite of Ixodid ticks or contact with blood or tissues of CCHF
patients or infected livestock. In December 2008, a re-emerging outbreak of
CCHF occurred in the southern part of Iran. 5 people were hospitalised with
sudden fever and haemorrhaging, and CCHF was confirmed by RT-PCR and
serological assays. One of the cases had a fulminant course and died.

Livestock was identified as the source of infection; all animals in the
incriminated herd were serologically analysed and more than half of them
were positive for CCHFV. We demonstrated that 2 routes of transmission
played a role in this outbreak: contact with tissue and blood of infected
livestock, and nosocomial transmission. Phylogenetic analyses helped to
identify the origin of this transmission. This outbreak should be
considered as a warning for the national CCHF surveillance system to avoid
further outbreaks through robust prevention and control programmes.

[byline: S Chinikar 1, S Mojtaba Ghiasi 1, M Moradi1, M M Goya 2, M Reza
Shirzadi 2, M Zeinali 2, E Mostafavi1, M Pourahmad 3, A Haeri 3,4
1. National Reference Laboratory for Arboviruses and Viral Haemorrhagic
Fevers, Pasteur Institute of Iran, Tehran, Iran
2. Centre for Disease Control (CDC), Ministry of Health of Iran, Tehran, Iran
3. Jahrom Faculty of Medicine
4. Shahid Beheshti University of Medical Sciences, Tehran, Iran]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[CCHF virus infections have occurred sporadically in cattle and people in
Iran since its introduction in 1973. An historical summary of these
outbreaks can be found in ProMED-mail archive no. 20100913.3303. This virus
can be transmitted to humans and livestock via Ixodid (hard) ticks,
exposure to blood and tissues of infected livestock, especially in
slaughterhouses, or nosocomially by contact with blood and secretions of
infected patients in the absence of barrier nursing and patient care.

A HealthMap/ProMED-mail interactive map of Iran can be accessed at
<http://healthmap.org/promed/index.php?v=32.7,54.2,5>. - Mod.TY]

[Birgitt]

CRIMEAN CONGO HEMORRHAGIC FEVER - SOUTH AFRICA: (NORTHERN CAPE)
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 31 Dec 2010
Source: The New Age [edited]
<http://www.thenewage.co.za/6913-1008-53 ... ongo_fever>


A 64-year-old from Petrusburg in the Northern Cape who fell ill after
being bitten by a tick has been diagnosed as having the deadly Congo
fever. Medically known as Crimean-Congo haemorrhagic fever [CCHF], the
disease has no cure and can kill sufferers within days. Symptoms may
include bleeding from all orifices of the body. The farmer became the
5th person to have contracted the disease in South Africa this year
[2010]. All the cases were confirmed by a state laboratory.

The farmer was bitten by a _Hyalomma_ tick last Thursday [30 Dec 2010]
and 2 days later he developed flu-like symptoms including fever,
headaches and body pains. The farmer was then taken to Kimberley
Hospital Complex, where he is being treated for CCHF.

Professor Lucille Blumberg of the National Institute of Communicable
Diseases yesterday confirmed that the Petrusburg farmer was suffering
from the dreaded CCHF after being bitten by a tick. She said that this
was the 3rd case of the disease reported in Northern Cape this year
[2010].

Blumberg revealed that another 67-year-old sheep farmer from Rouxville
in the Free State, who also has CCHF, was responding well to
treatment, and no secondary cases have been reported. "Congo fever is
not a common disease in Northern Cape, but it is not surprising when a
case is reported. Most of them occur in summer months," said Blumberg.
"Fortunately the doctors in the region are familiar with the disease
and its symptoms and always take safety precautions when a patient
shows symptoms of the disease at the hospital."

CCHF is caused by infection with a tick-borne virus (Nairovirus) [in
the family Bunyaviridae] which is acquired when a person is bitten by
a _Hyalomma_ tick. Symptoms include headache, high fever, back pain,
joint pain, stomach pain and vomiting. Those at risk of contracting it
are animal herders, livestock workers and workers at animal slaughter
houses. People who come into direct contact with Congo fever sufferers
are also at risk which is why patients suspected or confirmed are kept
in isolation.

Spokesperson for the provincial department of health Lulu Mxekezo said
the 64-year-old farmer was still in isolation at the Kimberly
Hospital. "Congo fever is highly infectious. People who came into
direct contact with the farmer are being closely monitored to see if
they present symptoms of the disease."

The disease is endemic in many countries in Africa, Europe and Asia,
and during 2001 cases or outbreaks were recorded in Kosovo, Albania,
Iran, Pakistan and South Africa.

The disease was 1st described in the Crimean Peninsula in 1944 and
given the name Crimean haemorrhagic fever. In 1969 it was recognised
that the pathogen causing Crimean haemorrhagic fever was the same as
that responsible for an illness identified in 1956 in the Congo. The
linkage of the 2 place names resulted in the name for the disease and
the virus. CCHF is a severe disease in humans, with a high mortality
rate.

[Byline: Ishmael Modiba and Zinhle Mapumulo]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[There have been sporadic cases of CCHF in South Africa over the
years. Fortunately, the hospitals treating these patients have
effective barrier nursing facilities, so that there has been no
transmission within the hospitals associated with these 2 cases. From
1982 - 1992, 101 human CCHF cases were reported in South Africa (see
ProMED-mail archive 19980318.0515). As the above report notes, this
virus is very wide-spread.

ProMED's Jack Woodall was first author of the paper describing the
isolation of Congo virus, from the blood of a human in the then
Belgian Congo, now Zaire. CCHF virus infections are often asymptomatic
in sheep and cattle, posing a threat to abattoir workers in contact
with blood of viremic animals. There were cases associated with an
ostrich farm and abattoir in South Africa in 1996 (see ProMED-mail
archive 19961105.1861).

Additional detailed information on Crimean-Congo hemorrhagic fever can
be found in the WHO Media Centre at
<http://www.whumberint/mediacentre/factsheets/fs208/en/>.

A map of the provinces of South Africa can be accessed at
<http://www.nationsonline.org/oneworld/m ... es_map.htm>.
A HealthMap/ProMED-mail interactive map of South Africa can be accessed at
<http://healthmap.org/promed/index.php?v=-29,25.1,5>. - Mod.TY]